Provider Demographics
NPI:1255069993
Name:MARESCO, MEREDITH
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:MARESCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 POLARIS PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8074
Mailing Address - Country:US
Mailing Address - Phone:614-865-4800
Mailing Address - Fax:614-865-4900
Practice Address - Street 1:110 POLARIS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8074
Practice Address - Country:US
Practice Address - Phone:614-865-4800
Practice Address - Fax:614-865-4900
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031528363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner